Both cardiac arrest and sepsis are primarily identified by vital sign abnormalities. However,
the practice of nurses and their designees routinely checking hospitalized patients' vital
signs every four to eight hours throughout the day and night has remained essentially
unchanged for over one hundred years. While respiratory rate has been shown to be the most
predictive vital sign for adverse events on the wards, it is often inaccurately measured and
poorly documented. For example, a disproportionate amount of respiratory rates are recorded
as either 18 or 20 breaths/min, which is often higher than actual rates.
We have previously statistically derived a physiology-based early warning score, called the
electronic cardiac arrest risk triage score (eCART), using vital signs and lab values. The
eCART was more accurate than scores commonly used in hospitals today. However, the vital sign
values utilized for our score were manually collected by nursing staff every four hours.
Recent technological advances have allowed for high-frequency measurement of pulse and
respiratory rate using a cableless respiration monitor. These devices allow for more frequent
and potentially more accurate measures of respiration, which may enhance the prediction
ability for detecting adverse events on the wards. In addition, the increase in monitoring
frequency may result in earlier detection of adverse events, which could translate into
further improvements in patient outcomes.
A subset of patients may be continuously measured using a telemetry system. The alarms and
ECGs from these patients are monitored by staff in a centralized station in the hospital.
When a clinical event requiring action is observed, a call is made to the unit alerting the
clinical staff that action is necessary. We will collect the continuous measurements
collected from this system and compare these continuous measurements to the high frequency
and manual measurements.
